Recommendations for Immigrants from Malaria-Endemic Countries Planning to Return "Home" to Visit Friends and Relatives

Every year approximately half of all of the cases of malaria in US travelers are among first- and second-generation immigrants (including their spouses) who traveled back to their country of origin to visit friends and relatives. For convenience, this group of travelers is referred to as VFR travelers.

Why are VFR travelers at greater risk?

There is no single reason why VFR travelers are at higher risk for malaria infection. Many factors contribute to this increased risk – not all of them may be true for all VFR travelers.

The duration of travel tends to be longer than for other types of travel such as business trips or packaged tours.
When visiting friends or relatives, travelers are more likely to stay at the houses of these friends and relatives rather than at hotels. Depending on the destination or socioeconomic status, private residences may be less likely to be air-conditioned or have screened windows.
VFR travelers are less likely to use the recommended malaria prevention measures, which places them at greater risk of infection than the other types of travelers who are more likely to use insect repellent and take chemoprophylactic medicines.
Again, reasons for this are complex, but may include some socioeconomic factors such as access to healthcare. Some recent immigrants may not have medical insurance or may not have established a relationship with a primary healthcare provider, which limits opportunities to receive appropriate preventive medical interventions including malaria prevention.
Another significant factor is the incorrect risk perception by the VFR travelers. Some VFR travelers consider themselves to be at low or no risk for infection because they grew up in a malaria-endemic country and consider themselves to be immune. This includes a belief that even if they are infected, the infection will be mild and easily treatable with medicines acquired while abroad.
However, VFR travelers should know that any partial immunity that they may have developed while growing up in a malaria-endemic country is lost very quickly after moving away making them as vulnerable to infection as people who grew up in non-endemic countries. Their children and spouses who may be accompanying them on the trip will also have no immunity against malaria. Also, depending on the destination, not all of the medicines that are available overseas to treat malaria may be appropriate or effective.

Do VFR travelers need to take special precautions to prevent malaria?

No. They simply need to use the same preventive measures that are recommended for all travelers. They should avoid mosquito bites by using a recommended insect repellent (especially if outside at night) and by sleeping under an insecticide-treated bed net if staying in an open-air accommodation. They should also start taking one of the chemoprophylaxis medicines recommended for their destination prior to, during, and for the complete amount of time after, travel.